1. science
2. medicine
3. orthopedics

Adding Orthopedics and Spine
to An Existing ASC
Michael McKevitt, Sr. Vice President Business Development
Bo Hjorth, Vice President, Business Development
James Lynch, MD, Contributor
Discussion Outline
• Our Experience
• Changing Dynamics in Healthcare Market
• Organization and Governance Issues
• Case Study
Our Experience
RSH’s Current Facilities
Span the Country
15
17
16
18
14
10
11897
2
3
6 5
4
1. Surgery Center of Mount Dora
Mount Dora, FL
10. Ravine Way Surgery Center
Glenview, IL
2. Peninsula Ambulatory Surgical Center
Under Development
Bayonne, NJ
Partnered with Bayonne
Medical Center
11. Swedish Covenant ASC
Under Development
Chicago, IL
Partnered with
Swedish Covenant Hospital
3. Robert Wood Johnson ASC
Under Development
New Brunswick, NJ
Partnered with Robert
Wood Johnson University Hospital
12.
The Center for Special Surgery at
TCA
San Antonio, TX
13.
Southern New Mexico Surgery
Center
Alamogordo, NM
14.
Cheyenne Surgical Center
Cheyenne, WY
15.
6. Medical Center at Elizabeth Place
Dayton, OH
Partnered with Kettering
Health System
Summit Surgery Center at Saint
Mary’s Galena
Galena, NV
Partnered With
Catholic Healthcare West
16.
7. Palos SurgiCenter
Palos Heights, IL
Partnered with Palos
Community Hospital
Surgery Center of Reno
Reno, NV
Partnered With
Catholic Healthcare West
17.
Advanced Surgery Institute
Santa Rosa, CA
8. Midland Surgical Center
Sycamore, IL
Partnered with Kishwaukee
Community Hospital
18.
Lodi Outpatient Surgery Center
Lodi, CA
Partnered with Lodi
Memorial Hospital
9. IL Sports Medicine and Orthopedic
Surgery Center
Morton Grove, IL
19.
Surgery Center of Anchorage
Anchorage, AK
4. Marietta Surgery Center
Marietta, OH
Partnered with Marietta
Memorial Hospital
5. Knightsbridge Surgery Center
Columbus, OH
Partnered with OhioHealth
13
12
1
19
Facility Includes
Ortho and/or Spine
Facility Has No
Ortho and/or Spine
4
Regent Surgical Health
• 18 of 19 current facilities do Ortho and/or Spine cases
• The three centers being developed all have Ortho and/or Spine
• Regent Spine Program / Visiting Surgeon
Changing Dynamics in
Healthcare Market
Economic Forces are Leveling the Playing Field
• There are more ASC’s now than there are hospitals
• Fewer new projects with fewer number of physicians available
for recruitment
• Each market is different but physician behavior (needs) is
consistent when it comes to recruitment
• Collaborative strategies will yield a larger opportunity
• Physicians who are historically Hospital-based are being
challenged
Reverse This Unsustainable Trend
Implant Costs vs. Surgeon Reimbursement vs. Hospital Profit
Joint Replacement Surgery
Implant Prices
(Up 171%)
Hospital Profits
(Down 92%)
$
Surgeon
Reimbursement
(Down 39%)
1991
2006
The Reality
“The future success of neurosurgical practice depends upon
efficient management and detailed business acumen.
No practice anywhere, whether private or academic, urban or
rural, general or subspecialty, solo or group, can escape the
financial vise of falling reimbursements and rising practice costs.”
James R. Bean, MD
Organization and
Governance Issues
Laying the Groundwork
• How Do you Get Started Adding Ortho and/or Spine?
• Board Approval
• Physician Recruitment
• Equipment Requirements
• Implant Costs
• Staffing Review
• Managed Care Contracts
Objectives of an
Ortho/Spine ASC
•
•
•
•
•
•
•
•
Enhance Patient Care
Promote Efficiency
Surgeon Comfort
Delivering Higher Quality
Achieve Financial Success
Avenue for surgeon control
Passive Income stream
Hospital partnership
Costs to Develop an Ortho and/or Spine Program
Spine
Orthopedics
Equipment
Power Equipment*
$140,463.16
Sm/Lg Bone Drill and
accessories
Pneumatic Micro Drill and
accessories
Positioning/Misc. Equipment
Power Equipment*
Estimated Cost
$150,714.49
Pneumatic/Electrical Drill
Lg Bone Battery Drill
Misc. Equipment
$17,576.07
Positioners
Immobilizers
Extremity Table
Beach Chair and Accessories
Plaster Spreader/Cast Cutter
Instrument Trays
Equipment
Estimated Cost
Neuro Microscope
Horseshoe Headrest
Cervical Headrest
OR Table Extender (for Spine)
Instrument Trays
$29,159.20
ACL Soft Tissue
Artho Dissecting
Hand/Micro Hand Wrist
Major/Minor Ortho
Arthroscopy/Open Shoulder
$16,128.75
Total
$203,327.20
$47,727.86
Lami Soft-Tissue
Cervical Laminectomy
Micro Neuro
Ortho Laminectomy
Retractor System
Total
Video Equipment/Accessories
$249,082.86
$447,525.20
*If Adding Both Ortho and Spine, much of the
Power Equipment is the same for both specialties.
Spine and Ortho Show Good Returns With Less Staff Time
Contribution Margin per OR Minute
Neurological Surgery
$48
Bariatric Surgery
$29
Pain
$28
Orthopedics
$20
ENT
$18
Podiatry
$17
OB/GYN
$14
Urology
$13
Ophthalmology
$4
Dental Surgery
$3
$0
$10
$20
$30
$40
$50
$60
Source : Data based on large Q2-Q3 ‘10 data of diversified RSH facility
14
Orthopedic Sub-Service Lines
Inpatient Revenue Contributions
Other
28%
Orthopedic sub-service lines:
• Joints
• Sports
Spine
53%
• Spine
Joints
19%
Outpatient Revenue Contributions
Spine surgery* provides:
• 21% of ortho inpatient
volumes
Sports
53%
Other
47%
• 25% of ortho inpatient
revenues
• 53% of ortho inpatient profits
*Although this data is reported through an orthopedic service line report, it is important to note spine surgeries performed by either
ortho- or neurosurgeons are included in the same DRG categories. Source: Innovations Center Futures Database Published in Future
of Orthopedics report by Healthcare Advisory Board; page 10, 11, 16, and 19. Updated 2005.
Case Study - Reno, NV
Outcomes
Reno NV ASC
• Joined Regent in 2005
• 115 Total Physician Utilizers
• 20 Orthopedic Surgeons
• 3 Spine Surgeons
• YTD 2010 – 4,250 Surgeries Performed
• 661 Ortho Surgeries
• 77 Spine Surgeries
Net Revenue
Spine and Otho Services versus Other Specialties
Adding New Services Conducive to Outpatient Environment
A small percentage of volume can translate
into a large percentage of revenue
3.0%
YTD 2010 Spine Cases
Volume
13.0%
Revenue
Average Monthly Spine and Ortho
vs. Total OR Cases
400
354
354
Approx. 354 Cases/Month
Approx. 6 Cases/Month Spine
Approx. 55 Cases/Month Ortho
350
300
250
200
Avg. Net Revenue
Ortho: $3774/Case
$207,877/Month
Spine: $17,166/Case
$110,148/Month
150
100
55
50
6
0
Ortho
Approx. Cases per Speciality
Spine
Approx. Total Cases
Overnight Capability = Higher Acuity Cases
22856: TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC)
Spine Cases – Overnight vs. Total
63030: LAMINOTOMY (HEMILAMINECTOMY), WITH
DECOMPRESSION OF NERVE ROOT(S), (OPEN OR
LAPAROSCOPIC)
30
24
25
20
20
17
15
Total Cases Performed
9 9
10
5
1 1
Total Overnight
4
2 1
1
1
63030
63042
63047
63047: LAMINECTOMY, FACETECTOMY AND
FORAMINOTOMY
63075: DISCECTOMY
0
22856
63042: (LAMINOTOMY (HEMILAMINECTOMY), WITH
DECOMPRESSION OF NERVE ROOT(S),
63075
63081: VERTEBRAL CORPECTOMY (ACDF)
63081
23470: (HUMERAL HEAD RESURFACING
(HEMIARTHROPLASTY)
Orthopedic Cases – Overnight vs. Total
24101: (ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION
200
177
27446 :(OXFORD PARTIAL KNEE REPLACEMENT
(ARTHROPLASTY))
150
27792: (OPEN TREATMENT OF DISTAL FIBULAR FRACTURE
100
Total Cases Performed
50
32
2 1
3 1
1111
4 1
11
1
Total Overnight
46
4
3
1
0
23470 24101 27446 27792 29807 29827 29881 29888
29807: (ARTHROSCOPY, SHOULDER, REPAIR OF SLAP
LESION
29827: (ARTHROSCOPY, SHOULDER, WITH ROTATOR CUFF
REPAIR
29881: (ARTHROSCOPY, KNEE, WITH MENISCECTOMY
29888: (ARTHROSCOPICALLY AIDED ACL REPAIR OR
RECONSTRUCTION
Conclusion
• Adding more complex cases can significantly
increase revenue
• Motivated and committed physicians and staff are
critical to the success of the center
• Manage for profitability and work to improve not
only the quality of care, but also the business of care
RSH’s Current Facilities
Span the Country
1. Surgery Center of Mount Dora
Mount Dora, FL
10. Ravine Way Surgery Center
Glenview, IL
2. Peninsula Ambulatory Surgical Center
Bayonne, NJ
Partnered with Bayonne
Medical Center
11. Swedish Covenant ASC - Under
Development
Chicago, IL
Partnered with Swedish
Covenant Hospital
3. Robert Wood Johnson ASC
New Brunswick, NJ
Partnered with Robert
Wood Johnson University Hospital
15
17
16
18
14
10
11897
2
3
6 5
4
5. Knightsbridge Surgery Center
Columbus, OH
Partnered with OhioHealth
6. Medical Center at Elizabeth Place
Dayton, OH
Partnered with Kettering
Health System
13
12
1
19
4. Marietta Surgery Center
Marietta, OH
Partnered with Marietta
Memorial Hospital
7. Palos SurgiCenter
Palos Heights, IL
Partnered with Palos
Community Hospital
8. Midland Surgical Center
Sycamore, IL
Partnered with Kishwaukee
Community Hospital
9. IL Sports Medicine and Orthopedic
Surgery Center
Morton Grove, IL
Facility Includes
Ortho and/or Spine
12.
The Center for Special Surgery at
TCA
San Antonio, TX
13.
Southern New Mexico Surgery
Center
Alamogordo, NM
14.
Cheyenne Surgical Center
Cheyenne, WY
15.
Summit Surgery Center at Saint
Mary’s Galena
Galena, NV
Partnered With
Catholic Healthcare West
16.
Surgery Center of Reno
Reno, NV
Partnered With
Catholic Healthcare West
17.
Advanced Surgery Institute
Santa Rosa, CA
18.
Lodi Outpatient Surgery Center
Lodi, CA
Partnered with Lodi
Memorial Hospital
19.
Surgery Center of Anchorage
Anchorage, AK
Facility Has No
Ortho and/or Spine
23
Thank You
Mike McKevitt, Senior Vice President
p: 312.848.5301
e: mmckevitt@regentsurgicalhealth.com
Bo Hjorth, Vice President, Business Development
p: 615. 477.9668
e: bhjorth@regentsurgicalhealth.com